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byrnema20

So you meant something like "counterfactually, it's more likely that Steve Jobs changed his mind about treatment than it is that he didn't get pancreatic cancer."

Yes, exactly.

I feel like phrasing this in terms of quantum mechanics ("the amplitude of outcomes where steve jobs changed his mind etc. etc.) actually makes it more difficult to support.

Yes, I feel like I've opened a can of worms in opening this line of questioning in my brain and now I'll have to think about it for a few hours.

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From Quora:

"Now Mr. Jobs always was a free thinker, a strong believer in spirituality, a vegetarian and a known skeptic of conventional medicine. He chose to reject conventional medicine altogether. He's not alone in that. We come across many people like this and we all know someone in our midst that uses homeopathy or has this known fear of anything "chemical" (to those I always say that everything is chemical, if you think dihydrogen oxide sounds scary you should stop drinking water). Individual freedom of thought and choice is a cornerstone of our modern society and the medical world makes no exception."

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[LINK] Why did Steve Jobs choose not to effectively treat his cancer?
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[-]Psychosmurf60

Simple google search yielded surprisingly interesting answers:

http://www.ukskeptics.com/article.php?dir=articles&article=why_people_use_alternative_medicine.php

The tendency is that people are more likely to use alternative treatments the more educated they are. The level of education a person has attained is probably the the best indicator that a person is likely to use some form of alternative treatment.

Being intelligent or well educated does not mean that a person is going to think more logically; in fact, it often results in them becoming better at defending and justifying their irrational beliefs.

Unfortunately, conventional medicine is not perfect; people do have bad experiences with it. This can lead people to distrust conventional medicine and sometimes shun it. This is only true of a small proportion of people, but the big danger for them is that they are more likely to use alternative remedies as their primary source of healthcare. These people often decide to take full control of their own, and possibly also their family's, health. The consequences of this may be damaging, even fatal.

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[-]prase80

Speculation: to an uneducated person medicine appears as magic. An educated person understands that doctors aren't conjurers and evaluates it as a bug; he wants magic to save his life.

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[-]Alexandros30

What is the strongest source we have for this? This[1] 2008 article, especially page 4, seems to be the best I can find, is there anything better?

[1] http://money.cnn.com/2008/03/02/news/companies/elkind_jobs.fortune/index.htm?postversion=2008030510

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[-]johnlawrenceaspden10

To those I always say that everything is chemical, if you think dihydrogen oxide sounds scary you should stop drinking water.

 

I really hate this sort of thing. 

If we're going to insist that everything made of atoms is a chemical, then we have no use for the word 'chemical', but we need a different word for the thing that people mean when they say 'chemical', which is 'nasty new thing made in a laboratory that's probably a poison because it wasn't present during our evolution'.

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[-]dlthomas10

Not everything is chemical - radiation therapy, for instance, isn't chemical.

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[-]buybuydandavis00

Recent article paints an even less rational picture of his battle against cancer. http://www.nytimes.com/2011/10/26/opinion/limits-of-magical-thinking.html

He was a control freak, yet when he learned he had a rare form of pancreatic cancer that would respond to surgery, he ignored his wife, doctors and friends and put the surgery off for nine months, trying to heal himself with wacky fruit diets, hydrotherapy, a psychic and expressing his negative feelings.

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[-][anonymous]00

Um, not to be That Guy, but this has been discussed elsewhere. Was there some specific direction you wanted to take the conversation, or...?

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[-]buybuydandavis-30

The "traditional alternative" is going to a doctor whose primary interest is to fill out insurance forms, keep the insurance companies happy, and minimize his legal risk, intellectual effort, and emotional hassle. Any solution will likely of a highly regulated, and therefore expensive variety.

The bonus of "alternative medicine" for most is that it puts control into your hands, allows you to experiment empirically, taking all the data you can, and applying it with the best information you can find to achieve a cure.

For anyone who has had a medical problem without a cookbook solution that could be looked up at WebMD, you know that doctors aren't primarily there to heal you, they're there to efficiently and with minimal effort process insurance forms while acting as a gatekeeper to drugs, treatment, and medical devices, guided by their own risk aversion to lawsuits or upsetting insurance companies or regulatory agencies.

I don't think any of that applies to Jobs, who no doubt could get doctors to do anything he wants. His problem was getting cured while minimizing personal cost (with finances being irrelevant in his case, except for stock price).

What's particularly puzzling about Jobs is the apparent lack of adequate monitoring of the disease progression. I can understand wanting to avoid the extremely invasive traditional measures by seeking a lower impact solution first, but it's hard to see how someone with more money than God could get caught with his pants down by the progression of his disease.

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[-]Desrtopa50

The bonus of "alternative medicine" for most is that it puts control into your hands, allows you to experiment empirically, taking all the data you can, and applying it with the best information you can find to achieve a cure.

"Alternative medicine" is very rarely supported by well documented research with good methodology. When it is, it tends to become mainstream.

You can experiment empirically with mainstream medicine, as with alternative medicine, but in both cases usually only with a sample size of one. Research in mainstream medicine is corrupted by publication bias and industries with vested interest in funding studies with positive results, but alternative medicine is even worse, adding complete failure to understand credible research design or statistics into the mix. Individuals engaging in personal experimentation tend to be no less prone to bias, and are in a much worse position to conduct meaningful research.

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[-][anonymous]160

Or, as Tim Minchin puts it:

"Alternative Medicine”, I continue “Has either not been proved to work, or been proved not to work. You know what they call “alternative medicine” that’s been proved to work? Medicine."

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[-]buybuydandavis-10

Which is to say that Alternative Medicine that works will be a decade or two ahead of Medicine. If you don't have a problem with being a decade or two behind the best treatments, or never getting a treatment because no one has an interest in spending a billion dollars to "prove" it works, limiting yourself to Medicine is not a problem.

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[-]JoshuaZ90

Which is to say that Alternative Medicine that works will be a decade or two ahead of Medicine

Sure, some forms of alt med might potentially fall into that category. But the vast majority will just be wrong and will often contradict basic laws of physics. Homeopathy is a good example of this.

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[-]buybuydandavis20

But if you happen to be rational, you can weed out the treatments that contradict the basic laws of physics.

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[-]mytyde-10

I'm not assuming that homeopathy works, but I have been unable to find good quality experimental evidence on it. Anyone can say it seems to violate the laws of physics, but the only way to be sure is to test it. It does have a reputation and takes its basis thousands of years ago in the writings of Hippocrates. It's not terribly crazy to withhold judgment. I'm looking for good quality experimental data on its effectiveness.

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[-]JoshuaZ10

Actually, homeopathy only dates to the 19th century.

Anyone can say it seems to violate the laws of physics, but the only way to be sure is to test it.

You can't be sure about anything. Everything has some small chance of being the case, but homeopathy is grossly at odds with very basic aspects of modern physics, including simple issues of reductionism. Don't privilege the hypothesis http://lesswrong.com/lw/19m/privileging_the_hypothesis/ any more than any other idea out there.

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[-]Desrtopa40

It doesn't take anywhere near a billion dollars to test a new medicine, and if there were a good reason for singling it out as worthy of serious investigation, drug companies would probably already be on it.

"Alternative medicine" mostly falls into two categories; procedures which would have to work by mystical mechanisms which our current scientific understanding suggests almost certainly cannot work, which mostly haven't been tested, and traditional folk remedies which could work by the same sorts of mechanisms as ordinary medicine. Most of the latter have been found not to work, since traditional folk remedies are a significant source which pharmaceutical companies investigate in search of new drugs.

The more plausible a piece of "alternative medicine" sounds, the more likely it is to have already been investigated and found not to work.

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[-]buybuydandavis30

It doesn't take anywhere near a billion dollars to test a new medicine, and if there were a good reason for singling it out as worthy of serious investigation, drug companies would probably already be on it.

The only good reason a drug company has to investigate a drug treatment is if they can make substantial money on it, which they generally can't with off patent drugs and natural compounds already in use.

In fact, when they have patent medicines for the same malady, they have every interest in seeing that off patent medicines are banned.

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[-]Desrtopa90

If a natural compound is already in use and works, drug companies have an interest in testing derivatives which can be made more effective or lower in side effects, and which can be patented. Aspirin and all forms of opiates are well known examples of drugs originating in this way.

"Drug companies can't patent natural compounds, so they don't bother to research them" is a commonly used excuse by alternative medicine industries, but in fact drug companies frequently do test natural compounds. It can be done cheaply with a small sample size, because they don't have to investigate all the potential side effects or whether it stacks up to all the drugs currently on the market, just whether it works well enough to merit being made the focus of further research to create new medications.

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[-]mytyde30

I would like to see sources that show drug companies to be far-reaching and impartial in their exploration of traditional medicines. A good question then is, since there are also a lot of medicine companies which promote traditional remedies, why are the larger pharmaceutical companies, which exhibit undeniable biases and pay out billions in false advertising lawsuits each year seen as the more valid side of the fence? Many of these natural health companies employ fully trained doctors and receive patronage from fully trained doctors, and are a growing industry in the US. Is it then rational to assume that an industry being far outspent by large pharmaceutical companies is picking up market share because the remedies it promotes don't work?

The whole basis of the argument to dismiss alternative medicines in this thread is based on the idea that it's possible for people to be irrational about their medical choices: but this is a rationalization, not a rational argument. So the current argument is both that:

A. non-alternative treatments don't work sufficiently better than alternative treatments for there to be a noticeable negative difference in switching to alternatives (since an abundantly obvious difference in quality of healthcare would not admit of people making the wrong decisions against coercive market forces).

B. alternative treatments fulfill some non-physical need of the patient which draws people to use them.

C. Following this line of reasoning, we should arrive at the conclusion that alternative treatments are no worse than non-alternatives. Since alternative treatments are usually less expensive and less invasive, and since they do meet non-physical need (as we have posited), there is certainly no basis for discrediting them.

I of course pose the ontological question: how exactly is one to presume to lump them all together? Or is the act of this division not also an act of bias towards those treatments associated with particular institutions?

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[-]Desrtopa10

I would like to see sources that show drug companies to be far-reaching and impartial in their exploration of traditional medicines. A good question then is, since there are also a lot of medicine companies which promote traditional remedies, why are the larger pharmaceutical companies, which exhibit undeniable biases and pay out billions in false advertising lawsuits each year seen as the more valid side of the fence?

Because the alternative medicine companies are even worse.

Both mainstream and alternative medicine companies try to skirt the line of what they can legally claim about their products under government regulation, but mainstream drug companies skirt the limits of what they can say while meeting the minimum standards of peer reviewed research, while alternative medicine companies skirt the limits of what they can say without meeting any standards of research whatsoever.

The whole basis of the argument to dismiss alternative medicines in this thread is based on the idea that it's possible for people to be irrational about their medical choices: but this is a rationalization, not a rational argument.

Can you please explain why it's a rationalization rather than a rational argument? People are clearly irrational about many things, to their own detriment. People spent hundreds of years if not more tossing around various folk cures for scurvy, when in fact there is only one chemical which works, and works perfectly, to cure it. That's countless people dying, and a major barrier to world exploration standing for centuries due to people's failure to find out what works when left to their own devices, when some very simple tests were able to lay the matter to rest forever. Even after the experiments that determined quite conclusively that vitamin C containing foods were necessary to prevent scurvy, there were explorers who refused to believe it. They continued to get scurvy. Why do you not accept as a rational argument the claim that people continue to behave in a similarly irrational manner with respect to medicine today?

So your argument is both that:

A. non-alternative treatments don't work sufficiently better than alternative treatments for there to be a noticeable negative difference in switching to alternatives (since an abundantly obvious difference in quality of healthcare would not admit of people making the wrong decisions against coercive market forces).

B. alternative treatments fulfill some non-physical need of the patient which draws people to use them.

No, this is not what I am arguing at all.

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[-]mytyde00

It's rationalization instead of a rational argument because postulating that people can sometimes be irrational (e.g.: believing traditional medicine to be magical) isn't an argument for them making that choice over another. By the exact same argument, you could posit the opposite and it would seem correct: e.g. that people choose non-alternative medicine because they perceive it to be magic.

It's practically axiomatic to say that people sometimes (even often) act irrationally, but you've defined one side as rational and the other as irrational, from what I can tell based solely upon your (unconvincing) arguments that 1. drug companies have broadly tested and dismissed traditional medicines and 2. that alternative medicines don't work in general. If this isn't what you meant, please elaborate.

My point about questioning your ontology was in pointing out that you seem to define "alternative treatments" as ineffective without using any data to back up your claims. If you define alternative treatments as ineffective without there being a meaningful ontological distinction unifying them, you're not making any argument at all but only arguing a tautology. I would argue that this false distinction is rooted in corporate marketing practices intended to guise economic bias behind a word-veil (not that you are doing it on purpose), just like the two American political parties try to define themselves as the correct choice despite there being little identifiable ontological difference between them.

Id est, corporations define things they like as medicine and other things as "alternative treatments", but the distinction between them is based upon concepts of economic ownership and maneuvering of the market instead of useful empirical evidence.

Excuse me, I didn't mean to say that this A-B-C argument was your argument. (I've corrected the single word in the original post which made it sound like that). I was making a statement about the only argument against alternative treatments which was developed enough to identify in this thread.

In regards to what you were arguing, I answered above by requesting some real data for your broad claims about pharmaceutical companies doing extensive research on traditional remedies.

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[-]Desrtopa20

My point about questioning your ontology was in pointing out that you seem to define "alternative treatments" as ineffective without using any data to back up your claims.

I suggest checking out this book for an abundance of such. It's a very good read in its own right besides. It's not that alternative medicine is ineffective by definition, but that it is effectively defined as "alternative" by not meeting the standards of evidence that we demand of mainstream medicine (which are pretty lax standards already.)

Corporations don't define things they like as mainstream and things they don't like as alternative, the Food and Drug Administration in America, and comparable organizations in other countries, upholds certain standards for evidence about medicine, and medicine becomes "alternative" by not meeting them.

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[-]buybuydandavis30

You can experiment empirically with mainstream medicine,...

That's nearly a contradiction in terms. Mainstream medicine, as a practice, refuses empirical experimentation on particular patients. Here's the disease. Here is the cookbook cure that has been sanctioned by some professional board, with backing by a billion dollar study that shows some statistical advantage over a whole population. If there is no such study, then the prescription is a shrug and a pat on the head.

Older family practicioners often aren't like that. They'll say "I don't really know what will work for you, but we can try a few things".

Think of a car mechanic. He thinks about how a car works, runs diagnostic tests, and swaps out parts. He doesn't have placebo controlled double blinded studies, and doesn't just shrug when he doesn't have a study, or doesn't have an immediate answer.

Individuals engaging in personal experimentation tend to be no less prone to bias, and are in a much worse position to conduct meaningful research.

I completely disagree. He is uniquely situated and motivated to conduct research to solve the problem at hand - his problem

If it works for you, then it works for you. No billion dollar study required, and it doesn't matter what the statistical averages are when you determine it works for you. That is the problem to be solved - an individual's problem. Given that he and no one else has possession of the system requiring fixing, he is in a very good position to do "research" to fix his problem, if he is not prevented by regulations and institutions barring him from tests, materials, and treatments. He has much more motivation to fix the problem than his doctor, who has a great many more compelling interests than healing his patient.

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[-]JoshuaZ100

That's nearly a contradiction in terms. Mainstream medicine, as a practice, refuses empirical experimentation on particular patients. Here's the disease. Here is the cookbook cure that has been sanctioned by some professional board, with backing by a billion dollar study that shows some statistical advantage over a whole population. If there is no such study, then the prescription is a shrug and a pat on the head.

This is actually not quite true. There's been a surprising amount of self-experimentation in medicine and experimentation on individual patients. Lawrence Altman's "Who Goes First?" is a somewhat dry book on this subject that looks at self-experimentation by doctors and scientists in history. Most examples are things where they do deliberate harm to themselves (e.g. trying to figure out how a specific disease is transmitted by trying all sorts of different methods of infection, or deliberately reducing their intake of some specific vitamin and measuring the effects) but others involve actively trying to cure diseases that they happen to have. (Edit: For one recent unsuccessful example see here).

If it works for you, then it works for you. No billion dollar study required, and it doesn't matter what the statistical averages are when you determine it works for you.

It is often difficult to tell if actually works for you or not. Self-evaluation is really tough, and when your sample size is one, the noise level can easily outweigh the signal. Still, there are actual steps that self-experimentation can include that help a lot. One can without too much difficulty double-blind self-tests with a help of a friend.

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[-]Desrtopa60

That's nearly a contradiction in terms. Mainstream medicine, as a practice, refuses empirical experimentation on particular patients. Here's the disease. Here is the cookbook cure that has been sanctioned by some professional board, with backing by a billion dollar study that shows some statistical advantage over a whole population. If there is no such study, then the prescription is a shrug and a pat on the head.

If no study shows that any treatment has a particular advantage over placebo, many doctors will prescribe a placebo. Prescribing actual medicines at random would be a bad idea, since there's no reason to arbitrarily privilege the hypothesis that any particular treatment will help you more than a placebo, and a placebo has less danger of side effects. Of course, you can always go to a drugstore and buy mainstream medicines which have been found to be useful for something to test on yourself, and like alternative medicine, this will give you something to point at when you get better, but it's not a very wise treatment plan.

If it works for you, then it works for you. No billion dollar study required, and it doesn't matter what the statistical averages are when you determine it works for you. That is the problem to be solved - an individual's problem. Given that he and no one else has possession of the system requiring fixing, he is in a very good position to do "research" to fix his problem, if he is not prevented by regulations and institutions barring him from tests, materials, and treatments. He has much more motivation to fix the problem than his doctor, who has a great many more compelling interests than healing his patient.

If mere motivation was enough to overcome bias and incompetence at processing evidence, we would have no need for this site at all.

The advantage of "alternative medicine" is that you can always turn to it for a harmless placebo, but this is much less useful once you know that it's what the advantage actually is.

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[-]mytyde00

The point is not for individuals to create generalizeable claims, but rather to allow idiosyncratic individuals with unique problems and life situations to improve their health. You cannot argue with the results individuals achieve. Of course, much of this individual research is only necessitated by the utter lack of reliable data:

"Researchers reviewed 546 drug trials and found that industry-funded trials reported positive outcomes 85% of the time compared with 50% of the time for government-funded trials and 72% of the time for trials funded by nonprofits or non-federal organizations. Among the nonprofit or non-federal studies, those that received industry contributions were more likely to be positive (85%) compared with those that did not have any industry support (61%). ... But the new study also showed that results of industry-funded studies were published within two years of the study completion 32% of the time compared with 54% for government trials and 56% for nonprofit or non-federal trials." http://articles.latimes.com/2010/aug/02/news/la-heb-studies-20100802

Corruption in the drug industry is not trivial in the least, and because of the economic organization of the world such bias will not be going away in the forseeable future.

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[-]Desrtopa00

I've never argued that research in mainstream medicine is good, only that "alternative" medicine is a worse alternative. If there is no evidence whatsoever that a piece of alternative medicine provides benefit over placebo, you're better off taking something for which there is even weak evidence of it being better than placebo. At least you should get the benefit of the placebo effect either way.

One common way in which industry funded studies are slanted is by measuring their drugs against placebo, when the relevant information is how they perform against the best drugs already on the market. A drug that comes out ahead in these tests may be strictly inferior to other drugs that are are available, but it's probably still better than alternative medicine, which reliably fails to outperform placebos.

If an individual takes alternative medicine and gets better, there's no point arguing that they didn't get better, but that doesn't mean that taking alternative medicine was a good idea.

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[-]lessdazed40

a doctor whose primary interest is

I am guessing from the way this is written that the sentence began as "a doctor whose primary interest is to fill out insurance forms" and then grew to be about "a doctor whose important interests include X, Y, and Z".

The reason I point this out is to say that it looks like you overwhelmed a bad cached thought pattern with subject-specific good thinking. The bad thought pattern is to assume that if there isn't a good predominant intention, there must be a predominant intention that isn't good.

The primary, strongest intention of the doctor could be to heal the patient with that being a very small part of his or her total motivation.

It is also important to note that intentions are less aligned with consequences than we tend to think. As Tolkien probably never said: not all purposes that wander are lost. There is a relationship between e.g. quality health care and low legal risk; information is lost at each instrumental value waystation from actions to terminal values, but humans are deft enough to usually not let it dissipate into nothingness.

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[-]dlthomas40

[I]f there isn't a good predominant intention, there must be a predominant intention that isn't good.

Did you borrow that from somewhere? I find it quite a clear statement of a common problem.

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[-]lessdazed20

Not consciously. But being wrong and saying oops may have helped me take that lesson to heart:

When I was very young, I thought that the ingredients section of a food label had to list, as the first ingredient, something that comprised over 50% of the product. If I still believed this, it would be easy to prove to me that a five-bean salad was mostly kidney beans. Simply show that none of the other four bean types made up a majority of the salad, and there you'd have it!

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[-]buybuydandavis20

I am guessing from the way this is written that the sentence began as "a doctor whose primary interest is to fill out insurance forms" and then grew to be about "a doctor whose important interests include X, Y, and Z".

That's probably true. In this case, I likely expanded with the litany of other distortions as I expanded the scope of my reply. But often, I find I engage in defensive writing and go back and qualify and expand just to fend of nitpicking.

The bad thought pattern is to assume that if there isn't a good predominant intention, there must be a predominant intention that isn't good.

I think that people arguing against me fall into that pattern - take my comments as an attack on doctors. I'm primarily attacking a system that subordinates my interests to the interests of a doctor, whose interests are subordinated to the medical industry and government.

I went to a doctor who wanted a private practice largely for the freedom to prescribe and help patients without a clinic's institutional oversight. We had a nice chat about it.

There was a treatment I found with multiple papers showing efficacy, and further papers showing safety at much higher doses than I was proposing. But the medicine was off patent, and had fallen into disuse. While he granted that it looked promising, he was concerned about liability on all sides, and those concerns made him feel he had to do extensive research on the drug before prescribing it. But he's not in the business of spending hours digging up research papers for a single patient. Not cost effective, for him.

I don't blame him at all. I'm not saying his interests are bad, they're just not identical with mine. My post was pointing out the numerous ways the institutional interests and incentives of "traditional medicine" are not aligned with the health and interests of patients, and the advantages that non traditional (and particularly, non regulated) treatments have over traditional medicine in that regard.

As far as "bad intentions", I don't blame doctors for trying to make money. I don't blame companies either. Again, I blame the supporters of a system that distorts the interests of doctors and companies and prevents me from pursuing my interests through legal channels, and opens me to criminal liability if I pursue my interests in my own health. I don't even say these people have bad intentions - their actions are just extremely harmful.

It's funny. Often the same people who want self medicating with psychotropic drugs legalized are the most adamant that self medicating with medicine should not be legalized. Surely, society will crumble if I can walk into a drug store and purchase a $4 prescription for simvastatin without a permission slip from a $200 appointment with a doctor first. But that's another story of a nitwit of a doctor completely clueless about statistics and risk, whose ignorance is granted control over my life by supporters of government control.

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[-]mytyde00

Your argument seems ideological to me. I certainly agree, this is how things should work, but I would see evidence before believing that the average medical professional really does learn from their mistakes.

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[-]byrnema10

I can understand wanting to avoid the extremely invasive traditional measures by seeking a lower impact solution first, but it's hard to see how someone with more money than God could get caught with his pants down by the progression of his disease.

Reading between the lines, my impression of the story (as given by 'google', but at least integrated over a few sources) is that his disease was typically slow-developing and it was expected there was some time. Jobs wanted to try the "diet approach". (There is a lot of information out there about links between diet and cancer; I don't know what to make of it but it's not pseudoscience, just highly 'organic' and non-linear). I have a strong sense that Job's plan was to try the non-invasive/wholistic approach until the cancer progressed. Perhaps he even felt like he was brave -- he wasn't rushing to have surgery but had the mind-over-fear frame of mind to explore alternative options. In parallel cases, it is sometimes overly dramatic to remove organs for fear of relapse when other treatments are nearly as effective. Consistent with this hypothesis, Jobs had the surgery as soon as it was determined the cancer was growing rather than shrinking It was still a textbook case -- got cancer, had surgery, now in remission, and Jobs gave a thank-goodness-that's-over speech.

However, unfortunately, in the end the cancer was growing even more aggressively than anticipated. Perhaps a cancer doctor can tell us what portion of the bell curve Job's cancer would be found in, that it was more aggressive than expected. If Job's approach would have 'won' most times according to his own utility function (given a random cancer, by selecting non-invasive approaches over surgery) then he could be more rational than appears in this particular Everett branch.

My motivation here is that I tend to credit consistently successful people with being rational, or at least good at winning, even if their methods seem strange or there is an element of gambling to their successes.

(I was downvoted just a point so far -- I hope to hear the reason for the disagreement, I suspect it is with my philosophy rather than with my assigned probabilities.)

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[-]Jack60

However, unfortunately, in the end the cancer was growing even more aggressively than anticipated. Perhaps a cancer doctor can tell us what portion of the bell curve Job's cancer would be found in, that it was more aggressive than expected. If Job's approach would have 'won' most times according to his own utility function (given a random cancer, by selecting non-invasive approaches over surgery) then he could be more rational than appears in this particular Everett branch.

If this is that case than Jobs behaved rationally, bet right but still lost. This has almost nothing at all to do with Everett branches.

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[-]buybuydandavis60

I have a strong sense that Job's plan was to try the non-invasive/wholistic approach until the cancer progressed. ...Consistent with this hypothesis, Jobs had the surgery as soon as it was determined the cancer was growing rather than shrinking It was still a textbook case -- got cancer, had surgery, now in remission, and Jobs gave a thank-goodness-that's-over speech.

My understanding is that the prognosis for the disease is very good if you catch it early, and poor if you wait too long, and that Jobs caught it early, but waited too long. So he was where the prognosis was good, and let himself get to where the prognosis was bad. Looks like a mistake to me. I don't know how closely he was monitoring his disease, but the assumptions above are evidence for "not too closely". A high enough prior that he would do the sensible thing would overcome this evidence.

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[-]lessdazed50

If Job's approach would have 'won' most times according to his own utility function (given a random cancer, by selecting non-invasive approaches over surgery) then he could be more rational than appears in this particular Everett branch.

I think this is why. Speak of what was reasonable for either him or a perfect inference machine to have expected given the information he had, but not of parallel universes with alternate histories.

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[-]byrnema00

I see ... in all nearby Everett branches he would have the same kind of cancer, but make different decisions. Further out, the cancers would only be subtly different from each other. Further out still, he might not have cancer at all, rather than different kinds of cancer.

Yes, it would have been much more accurate to speak of a perfect inference machine with the same information; only then could I integrate over all the possible cancers he 'might have had' as I intended. Thanks.

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[-]Nisan70

In nearby Everett branches Jobs would have made the same decisions.

EDIT: I think sometimes the concept of Everett branches are used in a misleading way on this website when people use the language of large-universe cosmology.

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[-]byrnema00

I was measuring 'nearby' as within a stone's throw.

EDIT: I think sometimes the concept of Everett branches are used in a misleading way on this website when people use the language of large-universe cosmology.

How so? I thought you were just quibbling about the meaning of 'nearby'..

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[-]Nisan60

If all the Everett branches that branched off of ours since Jobs discovered he had cancer were represented by a football field, then the branches in which Jobs made a different decision regarding that cancer would be represented by a single blade of grass way off on the touchdown line.

This is my understanding of the matter.

EDIT: The blade of grass next to it is one where Jobs forgets he has cancer, the one next to it is one where Jobs gives up his material possessions and becomes a monk, the one next to it is one where Jobs suffers brain damage due to an unexplainable quantum event in his skull...

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[-]JoshuaZ30

The blade of grass next to it is one where Jobs forgets he has cancer, the one next to it is one where Jobs gives up his material possessions and becomes a monk, the one next to it is one where Jobs suffers brain damage due to an unexplainable quantum event in his skull..

The last one is a much smaller blade of grass than the other two. But your basic point seems correct.

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[-]Nisan20

Do you think so? Maybe forgetting about the cancer could be caused by something happening to a handful of neurons or synapses. I'm not sure how many neurons would have to be messed with to make him an ascetic. A burst blood vessel in his brain could be lethal; I don't know if this would have to come about through a mechanical anomaly, or if an anomaly on the molecular scale could trigger it by inducing apoptosis.

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[-]JoshuaZ20

You are right. It isn't as obvious as I thought. The rough thought process was that we know that very rarely people on occasion do due the first two in response to diseases and terrible tragedies. But I wasn't thinking about the issue that I don't have a good estimate for what fraction of strokes and similar events are caused by unlikely quantum events. Without a better idea of how those numbers stand and a comparison for how much quantum dice rolling would be required for Jobs to have decided to become a monk I can't tell. I do suspect that the monk thing is more likely because Jobs was a member of a religious tradition that actually did that sort of thing. But without a lot more thinking this isn't much more than a vague intuition.

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[-]Nisan00

Yeah, I have a lot of uncertainty in this domain too.

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[-]Manfred40

I doubt you were measuring. You seem to be classifying only by features you care about, a common flaw when doing physics.

"Nearby everett branches" means universes in similar quantum states to ours. Everyone (recently) dead but in the exact same place is a much nearer branch than everyone alive but 1 cm to the left.

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[-]byrnema10

I was kinda measuring. My estimate was that given random flips in quantum states (many), it would be easiest (take order of magnitude fewer quantum flips) to change Job's decision, somewhat harder to change the type of his cancer or toggle whether he had cancer (for example, by changing the stochastic cell changes that led to his cancer) and require such completely different universes to change his type of cancer that it isn't even clear whether he could be considered Steve Jobs anymore.

Another way of looking at it is with subsets of universes. Consider the subset of universes where Steve Jobs was the CEO of Apple. In some of those universes, he made a different decision about his cancer. In a smaller subset, he had a less invasive cancer. Finally, the mass of universes where he had a different cancer is well outside him being the Steve Jobs we know of, since that would require a significantly different life history or different genetics profile. On the other hand, Steve Jobs indubitably had some other potential cancers that could have fired up, so the set isn't entirely empty.

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[-]Manfred30

So you meant something like "counterfactually, it's more likely that Steve Jobs changed his mind about treatment than it is that he didn't get pancreatic cancer." Because the evidence that could support this claim is mostly macroscopic statistical evidence, I feel like phrasing this in terms of quantum mechanics ("the amplitude of outcomes where steve jobs changed his mind etc. etc.) actually makes it more difficult to support.

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[-]byrnema80

(this comment written after this one)

So you meant something like "counterfactually, it's more likely that Steve Jobs changed his mind about treatment than it is that he didn't get pancreatic cancer."

Indeed, I'm beginning to see that alternatives that are counterfactually likely have perhaps no relationship with nearby Everett branches. For example, 'if I didn't become a chemist I probably would have been a biologist' may be true but nevertheless might have nothing to say about how near the two possibilities are in terms of quantum states.

A few interesting hypotheses have occurred to me that I'd like to think about more, but right now I'm a little confused about how two nearby Everett branches would look. What would the first divergence look like?

Most of what we experience is classical, and thus an averaged process of zillions of quantum states. Thus seeing anything different would require a huge statistical anomaly. For example, it's theoretically possible that a teacup will start floating on a table but it would be very unlikely and it's kind of hard to believe in. Is this the kind of thing to expect in any nearby Everett branch that actually looks different?

So now that I know i'm looking for a locally concentrated statistical anomaly -- rather than a scattering of changed states here or there -- this directs me to consider weird/unlikely events at the molecular level.

So for example, in nearby Everett branches it is relatively near for someone to not be born (since presumably a smaller number of molecular events are required for a particular conception) but given that they're born, not near for them to make a different decision at a certain point in time because presumably many molecular interactions are averaged to form decisions.

So: easy for Steve Jobs to not be here, but difficult for him to make a different decision. However, Steve Jobs being born or Steve Jobs not being born result in very different universes.

I'm thinking that once you add 'causality' to the mix, there very little reason nearby Everett branches will look like one another, from our point of view. That is, if the differences are large enough for us to notice, the results could just as likely be huge as inconsequential.

I feel confused and wonder if someone has already dissolved this?

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[-]Manfred30

One problem may be that you are not taking time evolution into account. Steve Jobs not being born and Steve Jobs being born are similar at conception. But because life is great at turning small changes into bigger changes, once the ovum starts replicating they can be quite far apart, and of course many years later there are huge differences :)

It's like chaos theory and predicting the weather - states might start out close together, but even tiny differences can give you totally different futures, because the difference can grow exponentially.

Nearby Everett branches will indeed look like one another. Right now, we're pretty far away from "no steve jobs" universe. But we were close in the past, which gives it that nice "alternate universe" feel.

And yeah, welcome to the wild world of infinite-dimensional spaces.

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[-]byrnema20

I started to form a counterargument and then realized that I had a really different (and unjustified) model of what was going on. Suppose one quantum state is different in one branch compared to another. This one state being different creates a ripple effect of new interactions that happen in that branch that can not happen in the second branch. Thus over time, the branches increasingly diverge in the similarity of their quantum states.

This updates my view, which was imagining a particular Everett branch as a 4 dimensional "matrix" of random numbers, each number representing the chosen quantum state of quantum at that location in space time. I thought you could then find nearby Everett branches by just changing a number at just one position in that matrix. In this model, you could have two Everett branches very near one another in which Steve Jobs was born and one in which he wasn't just by changing an area of values around the time and place of his conception. The two matrices would appear very different even though their quantum states were identical except in one small area of space time. I see now that I had thought of space time as discretized, quantum states were assigned to each discrete unit in a regular way, and the states were just read off as if from a tape, so that the tape could be the same before and after a perturbation. Instead, perturbations change the reading of the tape exponentially as time progresses.

Time is really important with this other view.

And yeah, welcome to the wild world of infinite-dimensional spaces.

Thanks

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[-]byrnema20

So you meant something like "counterfactually, it's more likely that Steve Jobs changed his mind about treatment than it is that he didn't get pancreatic cancer."

Yes, exactly.

I feel like phrasing this in terms of quantum mechanics ("the amplitude of outcomes where steve jobs changed his mind etc. etc.) actually makes it more difficult to support.

Yes, I feel like I've opened a can of worms in opening this line of questioning in my brain and now I'll have to think about it for a few hours.

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[-]JoshuaZ50

There is a lot of information out there about links between diet and cancer; I don't know what to make of it but it's not pseudoscience, just highly 'organic' and non-linear

This seems confused. There's a large amount of work showing that diet can help prevent cancer. Claiming that diet does much of anything after one has cancer is not at all justified by any decent scientific work.

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[-]byrnema00

OK, I understand your point. I'm not familiar with the literature on this topic.

However -- within this context of limited knowledge -- it seems to me that if diet can help prevent cancer it might also help in slowing it's progression, especially when you consider that there are a number of stages of cancer. Maybe with some cancers it would be an adequate solution if the cancer doesn't progress. That is, if diet is related to certain cell conditions that make certain stages of cancer less likely, it seems these same conditions would also make (a) the transition from a lower-stage cancer to these certain stages less likely and (b) might also make the transition from these stages to more aggressive stages less likely. This just to clarify that I am (potentially) wrong rather than confused.

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[-][anonymous]50

The stages of cancer do not classify cancers according to how aggressive they are (though, naturally, more aggressive cancers are more likely to be diagnosed at later stages). They just tell you how far the cancer has already spread. Any cancer, rightly so called, has already accumulated enough mutations to be capable of metastasizing, including mutations that greatly accelerate the rate of mutation. Once you have cancer, there's generally not much point in trying to slow down the process of developing cancer.

The link between diet and cancer risk is only supported for certain cancers, and is generally not as strong as I think people imagine--even for colon cancer, the effect of diet is nowhere near as strong as the effect of smoking on lung cancer risk, for example.

Even so, I upvoted your first comment, for being the only one here to point out that Jobs had a pretty indolent cancer, and that nine months' delay may or may not have made a difference to his outcome. There was a decent treatment of the question at Science-Based Medicine this week.

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